Outcome of retrograde ureteroscopy for the management of ureteric calculi: four years experience

ABSTRACT

To ascertain the efficacy of transurethral Ureteroscopy [URS] and Pneumatic Lithoclasty for the management of ureteral stones. This retrospective study was conducted from December 2005 to December 2009 at the Department of Urology and Renal Transplantation, Allied Hospital/Punjab Medical College, Faisalabad and Hospitals in Private sector. Patients with stones of different sizes and at different levels in the ureter were included in the study. Patients of less than 12 years of age and also patients with ureteric stones more than 3 cm were not included in the study.Such stones were managed by open Ureterolithotomy. A total number of 540 patients with ureteric calculi were included in the study. Cause of ureteric obstruction was stones in all cases. Among these 450 patients, 209 [38.6%] patients presented with lower ureteric stones, 266 [49.20%] patients presented with stones in the mid ureter, 65 [12.2%] patients presented with stones in the upper ureter. Bilateral ureteric calculi were present in 95 [17.5%] cases. Out of 540 cases 57 [10.62%] patients presented with anuria and they were initially treated by Percutaneous Nephrostomy PCN to relieve the obstruction followed by URS and Lithoclasty. Overall, ureteric stones at different levels and of different sizes were treated successfully in 480 [89.0%] patients and in remaining 60 [11.0%] patients stones could not be broken. Stones were successfully fragmented and cleared in the 198 [94.73%] of 209 patients with stones in the lower ureter, in 253 [95.11%] of 266 patients with stones in the mid ureter and in 29 [44.61%] of 65 patients with stones in the upper part of ureter. Stones were successfully fragmented in 347 [98.21%] out of 354, 92 [85.18%] out of 108 and 41 [52.56%] out of 78 patients with stone sizes of <1 cm, 1-2 cm and 2-3 cm respectively. DJ stents were inserted in 426 [78.81%] cases. Procedure was not successful in 60 [11.0%] patients. Stones were migrated up in to renal pelvis in 31 [5.73%] patients, stone fragmentation failure was in 13 [2.40%] patients, failure of URS insertion up to stone was in 6 [1.10%] patients and ureteric avulsion was in 1 [0.18%]. Transurethral rigid Ureteroscopy is still an acceptable procedure in the treatment of ureteric calculi of different sizes at different levels and it can be used safely with very good results in expert hands